Tracing shadows: How gendered power relations shape the impacts of maternal death on living children in sub Saharan Africa

Abstract

Driven by the need to better understand the full and intergenerational toll of maternal mortality (MM), a mixed-methods study was conducted in four countries in sub-Saharan Africa to investigate the impacts of maternal death on families and children. The present analysis identifies gender as a fundamental driver not only of maternal, but also child health, through manifestations of gender inequity in household decision making, labor and caregiving, and social norms dictating the status of women. Focus group discussions were conducted with community members, and in depth qualitative interviews with key-informants and stakeholders, in Tanzania, Ethiopia, Malawi, and South Africa between April 2012 and October 2013. Findings highlight that socially constructed gender roles, which define mothers as caregivers and fathers as wage earners, and which limit women's agency regarding childcare decisions, among other things, create considerable gaps when it comes to meeting child nutrition, education, and health care needs following a maternal death. Additionally, our findings show that maternal deaths have differential effects on boy and girl children, and exacerbate specific risks for girl children, including early marriage, early pregnancy, and school drop-out. To combat both MM, and to mitigate impacts on children, investment in health services interventions should be complemented by broader interventions regarding social protection, as well as aimed at shifting social norms and opportunity structures regarding gendered divisions of labor and power at household, community, and society levels.

Psychosocial health concerns among service-seeking orphans in the slums of Kampala

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Religious, socio-cultural norms and gender stereotypes influence uptake and utilization of maternal health services among the Digo community in Kwale, Kenya: a qualitative study

“…Gendered social roles affect the extent to which men get involved in sexual and reproductive health-related matters [7,8]. Gender dynamics also determine the level of autonomy that women have over decisions regarding their health [9]. In majority of communities in sub-Saharan Africa, which are predominantly patriarchal, men are the principal decision-makers, directly or indirectly influencing women's access to and utilization of health services [10,11].…”

Gender exploitative and gender transformative aspects of employing Health Extension Workers under Ethiopia's Health Extension Program

“…Gender inequality has been recognised as an issue in health service delivery, particularly in RMNCH programs in developing countries , but women's significant role in service delivery at the community level, and the gendered nature of human resources for health has been given little priority in research until recently . This reflects historical gender blindness within human resources .…”